EMT Standing Orders

• Routine Patient Care.
• Administer oxygen as appropriate with a target of achieving 94 – 98% saturation.
• Assist inadequate ventilations with BVM (bag-valve-mask ventilation). If respiratory arrest, manage airway with OPA/NPA and maintain oxygenation and ventilations with BVM (bag-valve-mask ventilation).
• Anticipate and avoid aspiration.
• Obtain glucose readings via glucometer.
• If blood glucose < 3.0 mmol \ L or 60 mg/dL with associated altered mental status, refer to Diabetic Emergencies (Hypoglycemia).
• If the patient’s mental status and respiratory effort are severely depressed (eg: narcotic overdose). Assist inadequate ventilations with BVM (bag-valve-mask ventilation). If respiratory arrest, manage airway with OPA/NPA and maintain oxygenation and ventilations with BVM (bag-valve-mask ventilation). See Poisoning/Substance Abuse/Overdose – Pediatric.
• If trauma can be excluded, transport patient in the coma/recovery position. If trauma suspected, see Advanced Spinal Assessment.
• Call for AEMT/Paramedic intercept, if available & Assisst them in patient care.
• Minimize scene time.

AEMT/Paramedic Standing Order:

• Establish IV/IO access.
• If hypoglycemia, administer dextrose. See Diabetic Emergencies (Hypoglycemia)
• If hyperglycemia, administer 10 mL/kg bolus of 0.9% NaCl IV/IO. See Diabetic Emergencies (Hyperglycemia) Protocol – Pediatric.
• For severe respiratory depression, administer naloxone 0.1 mg/kg IV/IO/IM/SQ/ intranasal, maximum dose 2 mg.
  • Consider restraint. See Restraints Procedure.
  • If no response, may repeat initial dose every 3 – 5 minutes to a total of 12 mg.
• Advanced airway as indicated.
• If hypotensive per age-based tables, administer fluid bolus 20 mL/kg 0.9% NaCl

  IV/IO.

  May repeat x 2.

  • Contact Medical Direction for additional fluid or medication orders.
• Assess and monitor cardiac rhythm. Treat as indicated per appropriate protocol.
• If suspect toxicology, refer to Poisoning/Substance Abuse/Overdose Protocol – Pediatric.
• If hypotension persists after 60 mL/kg fluid bolus, consider vasopressors, see Shock Protocol – Pediatric.
• If patient is violent or agitated, consider sedation. See Behavior Emergencies Including Suicide Attempts & Threats Protocol.